舒芬太尼在老年胃肠手术患者的药代动力学

Pharmacokinetics of sufentanil in Chinese elderly patients undergoing gastrointestinal surgery

目的观察舒芬太尼(麻醉性镇痛药)在老年胃肠手术患者的药代动力学特征。方法随机选择老年胃肠手术患者12例,ASAⅠ～Ⅱ级,年龄61～68岁,体质量62～70 kg;全身麻醉后,经前臂静脉一次性注射舒芬太尼2μg.kg-1,于注药后1,3,5,10,20,30,60,120,240和360 min采集桡动脉抗凝血浆1mL,注入真空试管,-80℃低温保存待测;用液相色谱-质谱联用法测定血浆舒芬太尼浓度,3P97药理学程序判断房室模型,并计算药代动力学参数。结果舒芬太尼在老年胃肠手术患者的血药浓度-时间曲线可用三指数函数方程表示,主要药代动力学参数t1/2π,t1/2α和t1/2β分别为(0.02±001),(0.20±0.05),(2.51±0.81)h;Vc和Vd分别为(0.55±0.10)和(9.01±0.75)L.kg-1;CL和AUC分别为(2.64±0.66)L.kg.h-1和(2.85±0.71)mg.h.L-1。结论舒芬太尼在老年胃肠手术患者的药代动力学符合三室开放模型,腹内压的变化可影响舒芬太尼的药代动力学特征,在临床用药时应根据患者的具体情况增减剂量以达最佳疗效。

Objective To study pharmacokinetics of sufentanil in elderly patients undergoing gastrointestinal surgery（GS）.Methods Twelve patients undergoing GS,ASA gradeⅠ-Ⅱ,age 61 to 68 years old,weighing 62 - 70 kg were studied.After general anesthesia sufentanil 2 μg·kg^-1 was administered as a rapid bolus intravenously.Blood samples were obtained at 1,3,5,10,20,30,60,120,240 and 360 min after sufentanil injection.1mL plasma was immediately separated from blood samples and stored at-80 ℃ until analyzed.Plasma concentration of sufentanil were determined by liquid chromatography mass spectrometry.Pharmacokinetic parameters were calculated by 3P97 pharmacological program.Results Pharmacokinetics of sufentanil in patients undergoing gastrointestinal surgery best fitted to three-compartment open model,main pharmacokinetic parameters were as follows： t1/2π,t1/2α and t1/2β were（0.02±0.01）,（0.20±0.05） and（2.51±0.81） h,respectively;Vc and Vd were（0.55 ± 0.10） and（9.01 ± 0.75） L·kg^-1 respectively;CL and AUC were（2.64±0.66）L·kg·h^-1 and（2.85± 0.71）mg·h·L^-1,respectively.Conclusion Pharmacokinetics of sufentanil in elderly patients undergoing GS fitted to three-compartment open model.The intra-abdominal pressure change may affect pharmacokinetics of sufentanil,when clinical medication should reach the best curative effect according to patient′s special details fluctuation dosage.